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PERMIT APPLICATI4N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, `NA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS�oj�j0 f��KE��1.1�-fZb. PARCE X I.D. # P htlT� <br /> SUI'T� 4�0 �4385'L4�oll00 ,�—� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS 21P PHON� <br /> t�ovu��c� ��-rr ��m ,�,�i��� a�. 9e2oro 258 • 7%02 <br /> ���c.ac._ c��� � o �x io�-� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> w�s� •�a�Ni+-�roF-l. ��v�� �a�r�o� 25�•a��� <br /> �-n�icAL Gt�ut� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> ki2rLE�f ccLE py�x�iP.TE2 1010 � EV�T'r� lv�L!_ Wi'tY KIiZTLGA2"72(2� <br /> PHONE �V�� IOZ %8�8 <br /> 425 •�• 04-0D ��SzE�'� <br /> PROPOSED USE OF BUILDING Building I'"1 Mechanical Addition HEAT SOURCE <br /> PERMIT Combinalion �_� Plumbing WORK Alteration Electnc <br /> ������' u"'���G TYPE Demolition �J Sign TYPE New R�—! Gas <br /> �AG'� Sprinkler Repaidh7ainL LJ Olher <br /> �ONTRACT PRICE OF WORK � � G�(�j, � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORKDESCRIPTION ��oL�otil o� �(E G-Xt�tt�5--1Gi v-!f<L�- �tt� ���ALLA�I�I�F—L �� <br /> s-��L u-sA�c�ta�� � i�-rat..L,a-ti� � �ew c.7' ca.�t>>o u���'�. <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> WATER CLOSET(TOILET) rVC—A/HANDLING UNI�S � <br /> BATHTUB FORCED AIR SYSTEMS <br /> I.AVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNII HE.4TERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISNWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKWG FOUNTAIN GAS FIREPLACE i <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE!BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I — — � <br /> _ I <br /> i <br /> i <br /> � I HEREBY CERITIFY THAT I HAVE REAU AND EW+MINED THIS APPLICATION AND KNOW THE SA61e TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK N'ILL BE COA1PLIeD WITH WHE i HER SPECIFIED HEREIN OR ii <br /> �� NOT. THE GRANTING OF A PERh-11T DOES NOT PRESUAtE TO GNE AUTHORIT.'TO VIOLATE OR CANCEL THE PROVISION GF ANY OTHER I <br /> � ST'rTE OR LOCAL LAW REGUV�TING CONSTRUCTION OR 7HE PERFORAfANCE OF CONSTRUCTION. THAT I A6d AUTHORIZED BY THE � <br /> , OIVNER OF THIS PROPERTY TO PERFORh1 THE`:VORK FUR ll'HIC4 AP°LICATION IS MADE AND I COA7PLY WITH THE STATE <br /> � CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> I ��/.,:. ��� JUt-lE. 2, 2GY�- ', <br /> Signature o(0 vner/ ontraetor'Aut�onzed Agent Date ; <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED 1'� I <br />